HomeMy WebLinkAboutHamilton PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Fl. 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description;
Property Tax ID #: - " – Lot Na.
Site Plan Name: Block No.
Project Name: id
Setbacks Front Back; Right Side;____ I.,eft Side:
ac, t 'V"4'1 nci o o4 +
(1j)'VAcoz(Y-n+cL1 Roilers -(i)FrcrIcV, Doc-"
Windows/Doors
Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ —640M Utilities: 01 Sewer 0 Septic Building Height:
Name–LJOCff L
JC —IC al ±�LL
Address:
City:
State:
Zip CodeA 4
Phone No,
Fill in fee simple Title Holder an next page ( if different
from the Owner listed above)
Narne:
Co m p a r1y;-171
Address:
City: State:IL
Zip Code; fax: 1721-28ic, 401-
ffj
Phone No.
-
E -(Mail: _Cy2rMjkS_,
State or County License;
value of construction Is $2500 or more, a RECORDED Notice of Commencement Is reciu
DESIGN ER/ENGINEER: Not Applicable
manne'
Address:---
City:
zip: Phone --
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Phone:—
BONDING COMPNot Applicable
Name:
—
Address:
Zip, Phone:--
OWNER/CONTRACTOR AFFIDVIT: Application is hereby rnade to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
Lucie akas no representationhi U| authorizeh permit holder structure
whichV| � aapplicable Home own orand covenants prohibit such
structure. Please consult with your Home Owners. Association and review your de6d for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree 'that I will, in all respects, perform the work
inaccordance with the approved plans, the Florida, Building Codes and St. Lwc|eCounty Amendments.
The following building permit applications are exempt froi-n undergoing a full corcurrency review: room additions,
accessory structures, swimming pools, fences, wails, signs, screen rooms pndaccessory w5estuanother non-residential use
WARNING TO OWNER: Your failure to Record a Notice mfCommencement may result| your paying twice for
improvements toyour property. /\ Notice fCommencement rnusthe recorded and posted onthe 'obsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
cumornendnRv«orkorrecurdingyourNo1iceofCornrnencenlent`~__~_____
^
'TATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF IWONTY
The forgoing instrurrient was acknowledged before n'ie
this day of 26T7by
ion
*Pp�esflmaking staternent
Personally Known _ OR Produced IdentifiratJQn
Type of Identification
Commission
Rev. W/17
TFI
KILL16MW«N
Notary Public ' State dFlorida
Commission # FF 929255
LCAFrWe
Nprow of pers�o?niaking statement
Personally Known _y
Type uf Identification , _ OR Produced Identification
Produced
(SignaturAof —N&ty Pqblic� St,,ate of Florida
Coniniission No.
"�,o% Notary Public - State of Florida
PLANS
13`"x gC"
i-AR55io
ZV,
?3"x
MR55 io
35,,.x2-4,~
HRS is
35 "R 25,
U13 i-Prc
zin,trq ,
32' KU,
r,v-vt-V-L4 AR650
3 7
� -1-n
-Res
qcc Nocdlonus bri
pov--t St . LU C I c, L 34-q 52-
6-r ...... )foi-idaa -j-,997 , !7/P�7 7'
-fir,_ � -, � 9 -.3 6 -